CAJ | 학술논문

目的探讨采用含异烟肼和利福平治疗方案对单耐异烟肼或利福平肺结核患者的治疗效果.方法收集2009年1月至2012年12月在广州市胸科医院治疗的异烟肼或利福平耐药的肺结核患者80例,采用异烟肼(H)、利福平(R)、吡嗪酰胺(Z)及乙胺丁醇(E)治疗2个月后痰菌仍阳性者的细菌耐药性进行回顾性分析.根据患者治疗前对异烟肼和利福平的耐药情况分为敏感组、单耐药组(异烟肼或利福平)和耐多药组(异烟肼和利福平均耐药).80例中男57例,女23例;年龄16～ 80岁,平均45岁;初治29例,复治51例.按治疗前对异烟肼和利福平是否敏感分为:(1)敏感组:37例,其中初治肺结核18例,复治肺结核19例;(2)单耐药组:15例,其中初治肺结核3例,复治肺结核12例;(3)耐多药组:28例,其中初治肺结核8例,复治肺结核20例.结果采用含异烟肼和利福平方案治疗后敏感组转为耐多药肺结核者2例,单耐药组8例,二者比较差异有统计学意义(x2=12.849,P=0.000);其中单耐异烟肼和利福平的患者治疗后转为耐多药肺结核的患者分别为6例和2例(RR=18.0,P＜0.05),单耐异烟肼较单耐利福平更易发展为耐多药结核.结论异烟肼或利福平单耐药患者中复治肺结核多见,采用含异烟肼和利福平方案治疗较易转变为耐多药结核病.临床上对复治肺结核患者应尽早进行异烟肼和利福平耐药检测,尽快采用针对异烟肼或利福平耐药的治疗方案.
목적 탐토채용함이연정화리복평치료방안대단내이연정혹리복평폐결핵환자적치료효과.방법 수집2009년1월지2012년12월재엄주시흉과의원치료적이연정혹리복평내약적폐결핵환자80례,채용이연정(H)、리복평(R)、필진선알(Z)급을알정순(E)치료2개월후담균잉양성자적세균내약성진행회고성분석.근거환자치료전대이연정화리복평적내약정황분위민감조、단내약조(이연정혹리복평)화내다약조(이연정화리복평균내약).80례중남57례,녀23례;년령16～ 80세,평균45세;초치29례,복치51례.안치료전대이연정화리복평시부민감분위:(1)민감조:37례,기중초치폐결핵18례,복치폐결핵19례;(2)단내약조:15례,기중초치폐결핵3례,복치폐결핵12례;(3)내다약조:28례,기중초치폐결핵8례,복치폐결핵20례.결과 채용함이연정화리복평방안치료후민감조전위내다약폐결핵자2례,단내약조8례,이자비교차이유통계학의의(x2=12.849,P=0.000);기중단내이연정화리복평적환자치료후전위내다약폐결핵적환자분별위6례화2례(RR=18.0,P＜0.05),단내이연정교단내리복평경역발전위내다약결핵.결론 이연정혹리복평단내약환자중복치폐결핵다견,채용함이연정화리복평방안치료교역전변위내다약결핵병.림상상대복치폐결핵환자응진조진행이연정화리복평내약검측,진쾌채용침대이연정혹리복평내약적치료방안.
Objective To study regimens containing isoniazid and rifampicin for the treatment of pulmonary tuberculosis with isoniazid or rifampicin resistance.Methods Eighty patients with isoniazid or rifampicin resistance,and whose sputum were still positive at the end of 2-month therapy with isoniazid (H),rifampicin (R),pyrazineamide (Z) and ethambutol (E),were retrospectively analyzed from Jan.2009 to Dec.2012 in Guangzhou Chest Hospital According to the Mycobacterium drug sensitive test (DST) before the treatment with isoniazid and rifampicin,the patients were divided into the sensitive group (either H or R sensitive),the multidrug-resistance group (both H and R resistance) and the single-resistance group (H or R resistance).There were 80 patients(57 females,23 males) whose sputum was still positive at the end of 2 month treatment.Their ages ranged from 16-80 (average 45) years.Among them,29 received the firsttreatment,while 51 received retreatment.There were 37 cases in the sensitive group,with 18 first-treatment patients and 19 retreatment patients.There were 15 cases in the single-resistance group,with 3 first-treatment patients and 12 retreatment patients.There were 28 cases in the multidrug-resistance group,with 8 firsttreatment patients and 20 rctreatment patients.Results After treatment,mycobacterial conversion to MDRTB occurred in 2 patients in the sensitive group,and in 6 patients in the single-resistance group.The rate of conversion to MDR-TB was higher in the single-resistance group than that in the sensitive group (x2 =12.849,P =0.000).Six patients with single H resistance converted to MDR-TB and 2 patients with single R resistance converted to MDR-TB (P ＜ 0.05,RR =18.0).Conclusions Single H or R drug-resistance was more common in retreated patients with pulmonary tuberculosis.If regimens containing isoniazid and rifampicin was used to treat patients with single H or R drug-resistance,resistant enlarging effect may appear and lead to MDR-TB.The retreated patients should be monitored as soon as possible for detection of Mycobacterium resistance to H and R,and regimens for H or R-resistance should be used to prevent resistant enlarging effect.